Hospital readmission after cardiac surgery imposes substantial clinical and financial burdens, particularly in resource-limited countries such as Nepal. Recurrent readmissions and unnecessary emergency visits create significant emotional, physical, and economic stress for patients and caregivers while increasing healthcare utilization and hospital stay. Inadequate discharge counselling and incomplete understanding of postoperative instructions further contribute to high revisit rates. Structured telephone follow-up may provide a simple and cost-effective strategy to bridge the gap between hospital discharge and recovery. It can reinforce adherence to medications, facilitate early identification of warning signs, and help to prevent avoidable emergency visits. International evidence supports its role in improving patient satisfaction and reducing readmissions. However, evidence from South Asia remains limited. Tailored implementation of structured telephone follow-up may serve as a practical strategy to improve postoperative outcomes after cardiac surgery in Nepal.
Background and Aims: Growing evidence suggests thattraining nurses in echocardiographic screening for latent rheumatic heart disease (RHD) detection could be a promising strategy, especially in settings where cardiologists are often inaccessible. This diagnostic accuracy study evaluated the feasibility and accuracy of nurse-led RHD focused echocardiographic screening in Nepal. Methods: The prospective diagnostic accuracy study consisted of three phases: training, screening and testing. Four nurses were trained in RHD-focused echocardiography for six weeks using a structured training module. Nurses were tested on an enriched, conveniently selected sample of 100 children aged 6-16 years (36 with RHD, 64 without) to ensure adequate statistical power for sensitivity estimates. Findings were compared with standard echocardiographic assessments performed by an expert pediatric cardiologist. Diagnostic accuracy was assessed using sensitivity, specificity, area under the ROC curve (AUC) and Cohen's kappa Results: Among all nurses, mean sensitivity and specificity for any RHD were 87.5% (95% CI: 84.3-90.7%) and 95.3% (95% CI: 93.2-97.4%), respectively, with almost perfect inter-rater agreement (kappa = 0.84, p<0.001). AUC ranged from 0.90 to 0.95. Sensitivity for borderline RHD was markedly lower at 47.9%. The mean time difference between nurses and the cardiologist was modest but statistically significant (00:32 min:sec for RHD-negative, 01:31 for RHD-positive cases; p<0.05). Conclusions: Nurse-performed echocardiographic screening following brief structured training demonstrated acceptable diagnostic accuracy for RHD in school-age children. Within a two-step model (nurse screener followed by cardiologist confirmation), task-shifting represents a scalable and equitable strategy for early RHD detection in resource-limited settings such as Nepal.
Background: The number of coronary arteries involved, the degree of stenosis, and the type of vessel involvement in patients with acute coronary syndrome determine presentation, morbidity and mortality. We aimed to determine angiographic findings in patients with acute coronary syndrome outside Kathmandu Valley. The data regarding angiographic profiles of patients undergoing coronary angiograms outside the valley is limited. This study aims to narrow the gap. Methods: A Descriptive cross-sectional study was conducted in the Unit of Cardiology, Department of Internal Medicine from January 1, 2022, to December 30, 2022, after ethical approval from the Institutional Review Committee (reference number 079/080-161). Convenience sampling was used. Point estimates and 95% confidence intervals were calculated. Results: Among 192 patients, majority of the patients were male with a mean age of 61.29 12.50 years. Triple vessel disease (TVD) was present in 77 (40.10%) patients. Left anterior descending artery (LAD) was most involved which was present in 157 (81.77%) patients. ST-elevated myocardial infarction (STEMI) as present in 134 (69.79%) patients. Diabetes mellitus was present in 122 (63.54%) patients, and it was the most common risk factor Conclusions: In our study, triple vessel disease and involvement of the left anterior descending artery were the most common angiographic findings. Diabetes mellitus was the most common modifiable risk factor, which could be the reason for multiple vessel involvement.
Background: Umbilical venous catheters (UVCs) are essential in neonatal intensive care but can rarely fracture and embolize, causing life-threatening complications. Management traditionally required surgery, but percutaneous retrieval offers a minimally invasive alternative. Case Presentation: We report a 16-day-old preterm male neonate (33 + 4 weeks, 1990 g) with a fractured UVC fragment that migrated from the right atrium across a patent foramen ovale into the left atrial appendage. The initial retrieval attempt was aborted due to bradycardia; however, following stabilization, successful percutaneous retrieval was achieved via the right femoral vein approach using a Judkins guiding catheter and gooseneck snare. Conclusion: Percutaneous retrieval of embolized UVC fragments is feasible and safe, even from unusual locations such as the left atrial appendage, and should be considered the preferred management option.
